67bpm; p=.002, adjusted p=.001), and this difference was most pronounced during night hours of 10PM to 5AM (61 vs. 67bpm; p&lt;.001). In the pilot analysis of the available PSG data, the release of obstructive sleep apneas and hypopneas coincided with fluctuation of HR.
SDB is independently associated with higher mean HR in patients with HCM, and this difference is most significant during sleep. Treatment of SDB, which is readily available, should be tested as a complementary modality to the currently recommended pharmacotherapy aimed at lowering HR in patients with symptomatic HCM.
SDB is independently associated with higher mean HR in patients with HCM, and this difference is most significant during sleep. Treatment of SDB, which is readily available, should be tested as a complementary modality to the currently recommended pharmacotherapy aimed at lowering HR in patients with symptomatic HCM.Endothelial function, as assessed with flow-mediated dilatation (FMD), and carotid intima-media thickness (IMT) correlate with the presence and extent of coronary artery disease (CAD). We investigated the incremental value of a combined evaluation of FMD and IMT in predicting the presence of CAD over traditional cardiovascular risk factors.
A total of 497 consecutive patients undergoing elective coronary angiography were enrolled in this study. Brachial artery FMD and ultrasound-based carotid IMT were evaluated prior to angiography. https://www.selleckchem.com/products/pf-573228.html CAD was defined as the presence of a?50% stenosis in at least one coronary artery. SYNTAX score was also calculated. Patients were categorized based on the presence of FMD and IMT values below or above gender-specific median.
Patients with both low FMD and high IMT presented the highest prevalence of CAD, number of diseased vessels, and SYNTAX score. At multivariate analysis, the combination of low FMD and high IMT was the strongest predictor of CAD (OR 3.63, 95% CI 2.19-6.02; p&lt;.001). At ROC curve analysis, the addition of FMD and IMT to a model of traditional risk factors improved the predictive power for the presence of CAD (area under the curve [AUC] of risk factors model 0.715; AUC of risk factors + FMD+IMT 0.780; p&lt;.001). The addition of FMD and IMT to the model of risk factors correctly reclassified 24.9% of patients.
A combined evaluation of endothelial function and subclinical atherosclerosis at the carotid artery level improves the ability of traditional risk factors to identify patients with CAD.
A combined evaluation of endothelial function and subclinical atherosclerosis at the carotid artery level improves the ability of traditional risk factors to identify patients with CAD.The study of arterial properties in patients with aortic valve stenosis who undergo transcatheter aortic valve implantation (TAVI) remains challenging and results so far seem equivocal. We sought to investigate the acute and long-term effect of TAVI on arterial stiffness and wave reflections.
We enrolled 90 patients (mean age 80.2±8.1years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Arterial stiffness was assessed by carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV). Augmentation index corrected for heart rate (AIx@75), central pressures and subendocardial viability ratio (SEVR) were assessed with arterial tonometry. Measurements were conducted at baseline, after TAVI and at 1year.
Immediately after TAVI there was an increase in arterial stiffness (7.5±1.5m/s vs 8.4±1.7m/s, p=.001 for cfPWV and 1773±459 vs 2383±645cm/s, p&lt;.001 for baPWV) that was retained at 1year (7.5±1.5m/s vs 8.7±1.7m/s, p&lt;.001 and 1773±459cm/s vs 2286±575, p&lt;.001). Post-TAVI we also observed a decrease in AIx@75 (32.2±12.9% vs 27.9±8.4%, p=.016) that was attenuated 1year later (32.2±12.9% vs 29.8±9.1%, p=.38), and an increase in SEVR (131.2±30.0% vs 148.4±36.1%, p=.002), which remained improved at 1 year (131.2±30.0% vs 146.0±32.2%, p=.01).
After TAVI the arterial system exhibits an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term.
After TAVI the arterial system exhibits an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term.The relative frequency of psychological factors in patients with spontaneous coronary artery dissection (SCAD) compared to patients with traditional atherosclerosis-related type 1 acute coronary syndrome (ACS) is unknown. This study examines whether psychological factors and emotional or physical precipitants are more common in SCAD patients versus atherosclerosis-related ACS patients.
Participants with SCAD were recruited from a Dutch SCAD database. Given the predominance of SCAD in women (&gt;90%), only female patients were included. The age- and sex-matched atherosclerosis-related ACS group was identified from a registry database. Online questionnaires and medical records were used to investigate psychological factors and clinical information. Univariate and multivariate logistic regression models were used to examine differences between 172 SCAD patients and 76 ACS patients on emotional and physical precipitants prior to the event and psychological factors after the event.
Patients with SCAD were more likely to experience an emotional precipitant in the 24h prior to the event (56%), compared with the ACS group (39%) (OR=1.98, 95%CI 1.14-3.44). Multivariate analyses showed that this association remained significant after adjustment for covariates (OR=2.17, 95%CI 1.08-4.36). At an average of 3.2years post-hospitalization for the SCAD or atherosclerosis-related ACS event, both patient groups had similar high levels of perceived stress (50% vs. 45%, p=.471) and fatigue (56% vs. 53%, p=.643).
This study shows that risk profiles for SCAD differ from traditional atherosclerosis-related ACS. Our findings may help health professionals to recognize SCAD and offer tailored rehabilitation and prevention programs.
This study shows that risk profiles for SCAD differ from traditional atherosclerosis-related ACS. Our findings may help health professionals to recognize SCAD and offer tailored rehabilitation and prevention programs.